•  Identify what needs to change to improve your performance
  • Agree with others as appropriate
  • Plan how the change will be made.
    • What resources are needed and who needs to be involved?
    • When will you start to make the changes?

3 doctors sat at computer looking at a document

Design your project to maximise the likelihood of change. Successful change is more likely where;

  • Staff members are motivated to improve practice in this area. If the audit was important to the author alone, or if there was limited support then it is less likely to bring about change to the system however in the case of a personal audit where the author is looking inward as to aspect of their delivery of care it may be beneficial to discuss with a colleague, a mentor or at appraisal looking to make improvements to that aspect of work over the next appraisal cycle
  •  All the key players are involved at the project design stage (people who will have the final say about any proposed practice changes)
  •  Robust methodology is used in your project – so you can assure others of validity and reliability of your results
  •  The drivers for and resistors to change are identified. These may be situational, environmental or personal (arising from positive or negative attitudes orthe availability of suitable skills and resources)
  •  Plans are made to use the drivers and overcome the resistors (but compromise may be necessary)
  •  There is understanding of why people may resist. Is it that they fear losing something important (e.g. status, autonomy, reward, influence) Staff may need to be taken on a ‘change journey’

Table 3 sets out the five stages that people may pass through when asked to make a change, although they may not necessarily go through each stage.

Table 3
Denial Denying that the change is necessary
Defence Protecting the current position
Discard / Accept Resignation to the fact that change is necessary
Adapting Making new ways work in spite of problems
Adopt Accepting the new way as the norm

(United Bristol Hospital Trust (UBHT) 2005)

Things may be worse initially after a change as people and systems adjust. Give it time.



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